Clinical research study
Fluoroquinolone prescribing in the United States: 1995 to 2002

https://doi.org/10.1016/j.amjmed.2004.09.015Get rights and content

Purpose

To measure changes in the rate and type of fluoroquinolones prescribed in the United States from 1995 to 2002.

Methods

We performed a longitudinal analysis of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey of adult visits to physicians in ambulatory clinics and emergency departments throughout the United States from 1995 to 2002. The main outcomes were fluoroquinolone prescribing rates and prescribing in accordance with Food and Drug Administration approval as of December 2002.

Results

Between 1995 and 2002, fluoroquinolones became the most commonly prescribed class of antibiotics to adults in the United States. Fluoroquinolone prescribing rose threefold, from 7 million visits in 1995 to 22 million visits in 2002 (P < 0.0001). Fluoroquinolone prescribing increased as a proportion of overall antibiotic prescribing (from 10% to 24%; P < 0.0001) and as a proportion of the U.S. population (from 39 to 106 prescriptions per 1000 adults; P < 0.001). These increases were due to the use of newer fluoroquinolones with activity against Streptococcus pneumoniae. Forty-two percent of fluoroquinolone prescriptions were for nonapproved diagnoses. Among patients receiving antibiotics, nonapproved fluoroquinolone prescribing increased over time (odds ratio = 1.18 per year; 95% confidence interval: 1.13 to 1.24).

Conclusion

Fluoroquinolone prescribing increased threefold in outpatient clinics and emergency departments in the United States from 1995 to 2002. Fluoroquinolones became the most commonly prescribed class of antibiotics to adults in 2002. Nonapproved fluoroquinolone prescribing was common and increased over time. Such prescribing patterns are likely to be followed by an increasing prevalence of fluoroquinolone-resistant bacteria.

Section snippets

Data sources

The NAMCS and NHAMCS are multistage probability surveys administered by the Ambulatory Care Statistics Branch of the National Center for Health Statistics of the Centers for Disease Control and Prevention.25, 26, 27 The NAMCS collects information on patient visits to non–federally funded, community, office-based physician practices throughout the United States. The NHAMCS collects information, in two components, on patient visits to hospital emergency departments and outpatient departments. The

Statistical analysis

We calculated standard errors for all results as recommended by the National Center for Health Statistics using SUDAAN software, which accounts for the complex sampling design of the surveys.29, 30 All statistical tests were based on estimates that had less than 30% relative standard error (i.e., the standard error divided by the estimate expressed as a percentage of the estimate) and were based on 30 cases or more in the sample data.

To assess changes in fluoroquinolone prescribing over time,

Overall antibiotic prescribing

Visits by adults with an antibiotic prescription increased from 75 million (95% confidence interval [CI]: 64 to 80 million) in 1995 to 95 million (95% CI: 80 to 109 million) in 2002. However, as a proportion of all adult ambulatory visits, antibiotic prescribing did not change during this period (12% in 1995 to 11% in 2002; P = 0.08). During this time, fluoroquinolones increased to become the most commonly prescribed class of antibiotics among adults in the United States (Figure 1).

Fluoroquinolone prescribing

The sample

Discussion

In 2002, fluoroquinolones became the most commonly prescribed class of antibiotics among adults in the United States. From 1995 to 2002, fluoroquinolone prescribing among adults increased threefold, while there was no change in overall antibiotic prescribing. Roughly half of fluoroquinolone prescriptions were for conditions not approved by the FDA, and these unapproved prescriptions rose over time, increasing by 20% per year. The increase in fluoroquinolone prescribing was attributable to the

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    Dr. Linder is supported by a Career Development Award from the Agency for Healthcare Research and Quality (K08 HS014563). Dr. Huang is supported by a Career Development Award from the National Institute of Aging (K23 AG021963). Drs. Linder and Huang were supported in part by National Research Service Award 5T32PE11001-12. Dr. Steinman was supported by the VA National Quality Scholars Program and a VA Research Career Development award. Dr. Stafford was supported by the Donald W. Reynolds Center for Cardiovascular Disease at Stanford University and a research grant from the Agency for Healthcare Research and Quality (R01 HS11313).

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